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PERMITTEE NAME/ADDRESS,hwtue c Fu-din NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS ;: I fJE <br />BOY PERMIT NUMBER DISCHARGE NUMBER <br />,R ENC E MONITORING PERIOD <br />FACILITY R N I i r_ YEAR MO DAY YEAR MO DAY <br />LOCATION DEN FROM TO <br />Form Approved. <br />OMB No. 2040-0OG4 <br />F - FINAL <br />POND F;'TR I B TO CANAX? IAN RIVER <br />NOTE. Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT #.: T:;, z 17: <br />FL iJ)=i•i .=F.i?tSS V<, .- REQUIREMENT r NAX ! . <br /> SAMPLE g a r 'r <br /> MEASUREMENT <br />-, .., PERMIT ###### ka:f ## #?f### REPORT i O. 5 -WIC; r' =f'.r. ' <br />:. F F LUEN T GROSS J'r, REQUIREMENT :30DA AV"; LiA I!- <br />f tr ' <br /> SAMPLE <br /> MEASUREMENT <br />L PERMIT ,._ r #####it # f-. i IP•I 'i; <br />-'ET-FLUENT GPOSS V REQUIREMENT <br />.i LLOW : 7 N '- --t ? 4).iU I T SAMPLE 1.., .. -., -• - <br />THRU TREATMENT PLAN MEASUREMENT <br />-,cG PERMIT REPORT r; >f#9t t##h## ?t ai}>i# z 1'f?•I C' <br /> REQUIREMENT U"A ?.VG . <br /> SAMPLE F =' 1 r r 4 i. . <br />:J i :IiAL MEASUREMENT <br />1 4?'?b <br />PERMIT <br />2?i i ?i tr <br />E5 i <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of luw that this document and di attachment were TELEPHONE DATE <br /> prepared under my direction or supcn tsion in accordance with a ."stern designed <br />?,? <br />Richard A. Munson to assure that qualified personnel properly gather and evaluate the infomw,on ! r <br />1 <br /> submitted. Based on my inquiry of the person or Perms who manage the system. t rl <br />- / <br />r <br />^ sident <br />Vice ur these Permms dvectl. responstblc f ,r gathering the mfortnuhon. the mfnnnauon <br />• <br />: <br />. d <br />l <br />t <br />d b <br />l ? <br />>G ', <br />I J 10 0E <br /> ief: true, accurate, an <br />comp <br />e <br />e <br />submitted is. to the best of my knowledge an <br />e SIGNATURE OF PRINCIPAL EXECUTIVE - <br /> I am aware that there arc significant penalne> for submitting false information. <br />li <br />i <br />d <br />f <br />k <br />i OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />TYPED OR PRINTED tre <br />nrn <br />. <br />nt rein . <br />including the Possibility of <br />ine and rmprsnnmcm <br />ng CODE <br />COMMENTS AND EXPLANATION OF ANY VIOLAI IUNJ Irreverence art anacnmencs nere) <br />YCIP EVENT SUBJECT TO BURDEN OF PROOF REQUIREMENTS IN <br />TO THE DIVISION WITHIN 48 HOURS. <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used.